The Defense Department's health care system is in need of an overhaul, and that must be a top national security requirement, the assistant secretary of defense for health affairs said last week.
Dr. Jonathan Woodson, the principal advisor to the secretary of defense for all matters relating to military health, spoke to young medical officers during the CJ Reddy Leadership Course at the Pentagon, March 24.
Military health care is still operating in a Cold War posture, he said, but the world has changed significantly since that time. For instance, he explained, large formations of troops were once stationed in West Germany, ready to defend against a possible Soviet and Warsaw Pact attack. Large, fixed hospitals were the norm.
Now, interoperable small teams deliver care to troops in far-flung corners of the globe. "We have to adjust our medical posture to provide care wherever men and women are being asked to go in harm's way," he emphasized.
Fiduciary Responsibility
The Defense Department's health care budget is about $50 billion annually, Woodson said. That's bigger than that of the entire Health and Human Services Department, the Food and Drug Administration, or the Labor Department. In turn, the entire DoD budget is half of the discretionary budget of the United States.
As such, he said, "we have a big responsibility as stewards of the taxpayer's dollar. If we're not, other segments of society will suffer, and eventually, that becomes a national security issue. So this is really important stuff."
Enterprise Management
While cost savings must be realized, "the American public expects us to deliver the standard of care or above the standard of care anywhere in the world," Woodson said. Balancing those two goals is "pretty tough," he added.
Four or five decades ago, he said, "a nurse was a nurse, a doctor was a doctor.”
“Many specialties didn't exist, [and] today's medical technologies didn't exist, so it was much simpler to administer care on a local basis and we didn't quite need enterprise management in order to increase economies of scale," he said.
A strategic line of effort Woodson said he's taken for the past several years since assuming his post is pursuing enterprise management for the military health care system -- "and that doesn't necessarily mean joint," he said.
What it does mean, he explained, is "creating economies of scale, decreasing variability, knowing where the dollars are going, providing common medical platforms [and] common business tools that allow us to do our jobs more effectively. We've got to do that."
It also means rethinking how care teams work, redefining the work flow, removing archaic rules and administration processes that impede efficiency and improved engagement with other agencies, Woodson said. In light of the changing national security and national health care environment, a pivot is now necessary, he added.
Global Health Engagement
Global health engagement is a new instrument of national power, Woodson said. During the recent Ebola outbreak in West Africa, the U.S. military medical mission there had a "strategic impact, with enormous second- and third-orders of effects," he said. The mission there prevented a complete destabilization of the entire region, from a security and economic perspective, Woodson noted.
Without that mission -- and without help from other U.S. agencies -- there could have been a ferment of insurrection and war, the assistant secretary said. "So," he added, "global efforts like this can prevent future kinetic operations."
Similar "robust efforts" are now underway in the Pacific region as well, Woodson said, noting his recent meetings with top Vietnamese leaders in Hanoi to discuss growing their medical capabilities. "That's enormous,” he said. “Think about the sea change" such meetings required.
People Priority
Another important pivot that needs to be addressed is better management of the medical force, Woodson said. By that, he said, he means across-the-board talent management, recruiting and retention, getting the right balance between the active and reserve components, career development, advanced training -- including with the private sector -- and leader development. Influencing change is also critical, he said. "You must learn to engage senior leaders to help shape future policy," he added.
About The CJ Reddy Course
The five-day CJ Reddy Course was started in 1992 as a leadership development program for the most promising lieutenants and captains in the Nurse's Corps. This was the first year that the course was opened to junior officers across the entire Army Medical Corps, as well as medical personnel across the Defense Department.
The course features a number of high-level speakers from across DoD and other agencies. While some of these leaders are from the medical field, others are not. For example, a lieutenant general gave a talk about the importance of mission command and how the medical corps plays a small but significant role in that.